Anterior Pelvic Tilt: Causes, Diagnosis, and Exercises

What is anterior pelvic tilt?

An anterior pelvic tilt is a short-arc anterior rotation of the pelvis over the hips when the upper body is upright and stationary. Viewed from the side, a person with a tilted pelvis will appear to have a deeper curve of the lumbar spine (the lower portion of the spine) and an exaggerated protrusion of the butt. Although poor posture can cause you to appear as though you have an anterior tilt of the pelvis, it’s important to have a proper medical examination to determine the severity of the tilt and check for muscle imbalances that can cause difficulty with mobility. 

An anterior pelvic tilt will naturally extend the spine, resulting in lumbar lordosis, or a larger curvature of the lumbar spine. Over time, lumbar lordosis can lead to lower back pain, stiffness, and complications with range of motion. Lordosis refers to the degree of curvature of the lumbar spine, and this tilt is the visible result of an exaggerated lumbar lordosis.

Test for anterior pelvic tilt

Your doctor can generally visually determine whether you have an anterior pelvic tilt through an exam that includes having you bend over, lie flat on your back, and stand up straight. They will also feel your spine and pelvis as part of the initial physical exam.

Another component of this test is a procedure known as the Thomas Test. This test is conducted while you lie on your back on the examination table. The doctor assesses your ability to stretch your legs, one by one, alternating knees to chest, to see whether the resting leg touches the table.

You can also do this at home, lying on your own table or workout bench and gently pulling one knee to your chest, then repeating on the other side. The degree of flexibility you have and the tightness of the muscle groups may give a positive result for the Thomas Test.

Depending on the results of the physical exam, your doctor may also recommend X-rays for a closer look at the condition of your spine and to see if there’s any damage to the cartilage. Your treatment will be determined after the exam. 

Causes of anterior pelvic tilt

Weak core muscles can contribute to the degree of anterior pelvic tilt and increase the degree of lumbar lordosis. Poor posture and a sedentary lifestyle, especially one that involves prolonged sitting in a hunched-over position, are some of the main causes of having a pelvis tilted towards the anterior. An imbalance of muscles pulling on the lumbar region of the spine or pelvis in general often contributes to the tilt. Lack of exercise, specifically strength training and certain kinds of isometric muscle development, can also contribute to weak phasic muscles and thus anterior pelvic tilt.

Obesity is another cause of anterior pelvic tilt. Obese people (BMI of 35 or greater) may have a more sedentary lifestyle and weaker muscle tone. In addition, the excess weight pulls on the spine and can lead to muscle imbalances that, in turn, can exacerbate pelvic tilt and a lordotic curvature that’s already outside the normal range.

How to treat anterior pelvic tilt

The most effective treatment for anterior pelvic tilt is building muscle strength in the pelvic region. Physical therapy may be useful, especially targeted exercise plans. Regular checkups from a doctor or physical therapist to monitor improvements can help reduce the presentation of the tilt of the pelvis and the resultant lordosis. Many exercises for treating this condition are small and involve the flexion and extension of the lumbar spine. 

Exercises for anterior pelvic tilt

People with poor lordotic posture typically have an excessive anterior pelvic tilt. This muscle imbalance can cause the hip flexors to be shorter and tighter than usual, which can result in chronic lower back pain or muscle spasms and difficulty walking. 

Many women who have anterior pelvic tilt also have weak abdominal and gluteal muscles. Building strength and flexibility in all these muscle groups is a critical first step to treating pelvic tilt. Slow stretching of the hip flexors and hamstrings, coupled with carefully building muscle tone in the abs and glutes, can help stabilize the postural muscles.

Those who have a tilted pelvis due to chronic obesity will need to follow a careful exercise regimen in order to prevent injuries as they build muscle tone. Moderating diet and reducing caloric intake will make this process easier on the body. A physical therapist or professional fitness trainer can help design a personal workout plan.

If you’re unable to get to the gym, don’t give up on exercises to help improve this condition. There are several things you can do easily in your own home with no equipment other than your own body weight. The number of repetitions in each set and the number of sets you do will depend on your level of fitness, so make sure you don’t overextend your physical capability.  

Bodyweight squats

You might be surprised by the workout you can get from squatting your own weight. You can do a bodyweight squat by bending at the knees and sticking out your rear — like you plan to sit down in a chair. It’s important when starting out not to go too low. Even if you have the flexibility in your knees and balance to sink down low, using weakened glutes and leg muscles to push yourself back upright can lead to strained muscles. Squat as far back as you can comfortably, stand back up, and repeat. Small repetitions in succession, followed by rest, then another short set of repetitions, can help improve the strength of your glutes.

Pelvic tilt

This may look like a lazy crunch, but it focuses on gently conditioning the pelvic floor. Lie flat on your back with your knees bent at a comfortable angle. Squeeze your pelvis up, pressing your back against the floor. Hold for 5–10 seconds and relax. Do this for several repetitions at a time, with rest in between each set.

Kneeling leg raises

This exercise is also known as a donkey kick, and it should be done slowly and deliberately. Kneel on all fours, preferably on a yoga mat. Keep your hands in line with your shoulders and fingers comfortably separated. Begin with one leg reaching back, stretching until it’s fully extended with the toe pointed. Bring your leg back down to the initial position. Repeat with the other leg. Form in this position is important — don’t arch your back. The goal is to increase the strength and flexibility of your hip flexors.

Kneeling hip flexor stretch

This is another exercise that uses small movements to help increase strength in the phasic muscles and small stabilizing muscles that help keep the pelvis in line. Begin by kneeling on your left knee, with your right leg at a 90-degree angle, knee over the toe, and your hands resting on the right thigh for stabilization. Slowly lean forward into your right hip, with your pelvis and back stable. Hold for 20–30 seconds and repeat on the other side, alternating sides for 5–10 sets.

This will be a small movement, focusing on stretching and balance. Only lean forward until you feel a gentle stretch of the hip flexors (the sides of the hip), and don’t lean further in than you can comfortably bring yourself back to the original position.

Glute bridges

This exercise helps you build your glutes and pelvic floor. Lie on your back, using a yoga mat for comfort and to keep your feet in place. Keep your knees bent and feet shoulder-width apart. Place your arms to your sides, palms down. Squeeze your glutes together while lifting your pelvis up. Relax your glutes to lower your hips back to the floor. For people who have weak lower abs, especially if you’ve had damage from pregnancies or a C-section, it’s important to use only your glutes to raise and lift your hips. Core damage and overextending with this exercise can strain weak or separated abdominal muscles.

Plank

This is another isometric exercise that engages the primary core muscle groups, like the abs, and the smaller muscles that help the abs, glutes, and postural muscles engage together. Plank exercises can be modified depending on your core strength. Begin with your forearms on your yoga mat and your knees bent. Move one leg fully extended behind you, with the ball of your foot on the mat. As you’re able, extend the other leg in the same manner.

Doing a plank correctly involves keeping your pelvis in line with your legs and spine. If you lift your butt too high in the air, you aren’t getting the full benefit of the position and won’t be engaging the muscles you need to develop to counteract a tilt in your pelvis. Keeping a good form is the most important part of a plank, even if you can only hold it for a couple of seconds.

Wrapping up

Treating an anterior pelvic tilt mainly involves losing weight and building muscle. Reducing the time you spend sitting without movement can also help. However, diagnosing and determining the best course of treatment should always be a decision made between you and your doctor.